(June 10, 2004) - After the Gulf War ended, Pam Pelle's battle continued.
Pelle, a nurse and Army Reserve staff sergeant with the Akron-based 2291st Army Hospital, was called for active duty during the late fall of 1990. For six months, she worked at Walter Reed Army Medical Center in Washington, D.C., nursing returning troops who had severe orthopedic injuries. Day after day, she tended to soldiers who had lost arms or legs and listened to their battlefield stories.
After she returned home to Copley, Pelle had nightmares and lost weight. A year later, hours after delivering her first baby, she started to hallucinate in her room at Akron City Hospital.
``I started screaming,'' she recalls. ``I was under overhead fire. I could see Scud missiles. Then, one by one, I could see every amputee I had taken care of during the war.''
Shell shock. Combat fatigue. Post-traumatic stress disorder. For generations, such terms have described the way combat can batter the psyche, as well as the body. Typically, the image of a troubled veteran was that of a man.
But in the past two decades, an increasing number of women have put on military uniforms, and many of them now fill combat roles. Currently, the United States has about 216,000 women on active duty worldwide, with another 151,000 in the Reserves and National Guard.
In the ongoing fighting in Iraq, female soldiers have been killed, captured and gravely wounded.
Experts have long known that men and women react differently to stress. For example, women are more at risk for post-traumatic stress disorder, or PTSD, a debilitating mental health condition that can be triggered by various life-threatening situations such as assault or natural disaster, as well as combat.
Now, the Department of Veterans Affairs has launched a$5 million study to determine what type of psychotherapy works best for women suffering from PTSD. Continuing through 2005, the study is the largest ever to focus on psychotherapy for PTSD.
``About 20 to 25 percent of the women who served in the Vietnam War and the Gulf War developed PTSD,'' says Paula Schnurr, deputy executive director of the VA's National Center for PTSD in White River Junction, Vt., and the study's co-director. ``We'd expect the figures for women serving in Iraq to be at least as high.''
Lucy Bland is a 53-year-old nurse-anesthetist at Cuyahoga Falls General Hospital. She's also a lieutenant colonel in the Army Reserves who was stationed at Al Asad, Iraq, last fall.
Although she is coping well, since returning home to Cuyahoga Falls in January after three months' duty, she believes that a great many returning soldiers will suffer from stress-related problems.
``It's not like there is a front line,'' Bland says, ``so anyone can be a victim.''
And women veterans, she believes, may be especially affected by the war.
``I think women are different than men,'' she explains. ``I think women take things more seriously, and are more intensely feeling.''
Indeed, when it comes to mental health, women and men are put together differently, says Dr. Patricia Resick, a psychologist and director of the Women's Health Sciences Division in Boston, a research and education center run by the VA.
Resick and her colleagues study not only PTSD, but other mental-health problems, such as marital difficulties, that veterans can experience after combat.
``Women generally are definitely at higher risk for mood disorders, (such as depression and anxiety),'' Resick says. ``Men are at higher risk for substance abuse and aggression. So there are some sex differences on how people deal with their stressors.''
Experts don't exactly know why men and women react to stress differently. It's unclear how much of the difference is due to genetics and how much is due to environmental factors.
Consider post-traumatic stress disorder:
This condition brings with it both biological and psychological symptoms, such as sleep disturbances, anxiety, altered brain-wave activity and relationship problems.
PTSD can occur when a person experiences or witnesses life-threatening situations. However, most people exposed to these situations don't get PTSD.
One risk factor for the condition is having undergone a previous trauma.
Resick says that by the time a woman reaches adulthood, she is much more likely to have been a victim of abuse than a man, particularly when it involves childhood sexual molestation or domestic violence, which are especially devastating to the psyche.
If a woman who previously was abused enlists in the military and experiences more trauma, Resick says, she is more likely to develop PTSD.
Combat isn't the only potential trauma facing women in the military.
American female soldiers have a high risk of being sexually harassed by male troops, says Dr. Stevan Hobfoll, director of the Center for Traumatic Stress at Summa Health System.
And the potential for sexual assault by the enemy can create another fear.
``There was a high level of rape by the enemy in the Gulf War,'' says Hobfoll, who adds that today's female soldiers are likely to have heard of this from female veterans.
A sense of unpredictability and helplessness contributes to mental stress. Many of the women currently on active duty are reservists who weren't expecting to go to war.
``When we have a war fought by regular military, they expect to go,'' Resick says. ``But reservists aren't prepared, particularly young women who are trying to raise children and worry about what's happening to their children at home.''
In Iraq, troops often have contact with their families at home through e-mail, she adds. This doesn't necessarily help a woman cope better; in fact, it may make stress worse.
``Strangely enough, having a lot of contact with home can keep you actively involved, but helpless,'' Resick says. ``You can't really intervene. Feeling helpless doesn't necessarily lead to PTSD, but certainly can lead to other problems.''
Former Staff Sgt. Janice Bragg of Stow, like Pelle, served as an Army Reserve nurse at Walter Reed during the Gulf War. Her husband, Paul, a reservist, also was assigned to Washington.
When she was called up, Bragg, then mother of a 7-year-old, had to sign over custody of her son, Justin, to his grandparents.
``It's the hardest thing in the world to have a lawyer draw papers,'' she says.
Bragg, who didn't see her son for four months, talked to her little boy on the phone and felt helpless to help him when he was struggling.
``The kids taunted him,'' she says. ``On the school bus, they would say, `Hey, we saw your mom and dad on TV last night. They got shot' ''
Even though she didn't participate in combat, Bragg found it very difficult to ``put her life back together'' when she returned home. Ashamed that she had developed problems when she hadn't even entered the battle zone, she didn't seek any sort of help from the VA.
``We were trainers,'' she says. ``We trained other (reservists). How would I be able to explain my weakness? I couldn't handle something that I had trained for 10 years for.''
Today, nearly 15 years out of the Reserves, Pelle, 40, and Bragg, 43, are engaging women in stable marriages. Best friends, they are veterans proud to have served their country. Both have had more children.
But they both insist that the public needs to realize that veterans who return from active duty during a war need support, whether that duty was on American soil or in the Iraqi desert.
Pelle says that when she finally told her family doctor about her nightmares and other problems, he told her that she needed ``to just get over it.''
``It was the wrong thing to say to anyone who has come back from active duty,'' Pelle says. ``Because you know what? It doesn't work that way.
``You don't just get over it.''
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